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Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial

View Article: PubMed Central - PubMed

ABSTRACT

Background: Regenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n = 10) or control group (n = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry.

Results: Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively.

Conclusions: A single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.

No MeSH data available.


Related in: MedlinePlus

Clinical findings after PRP and saline treatment of SDFT lesions over time. a Degree of lameness. b Scores for sensitivity to palpation. c Scores for skin surface temperature in the palmar metacarpal region. Mean ± SE; global test for PRPG and CG p < 0.001; Different letters (PRP normal and control italic) indicate significant differences (p < 0.05) within groups; PRPG = PRP-group: n = 10 limbs, SDFTs treated intralesionally with PRP; CG = control group: n = 10 limbs, SDFTs treated intralesionally with saline; black arrow = day 0: diagnosis, intralesional injection of PRP/saline; PRP = platelet-rich plasma; w = weeks; SDFT = superficial digital flexor tendon
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Fig1: Clinical findings after PRP and saline treatment of SDFT lesions over time. a Degree of lameness. b Scores for sensitivity to palpation. c Scores for skin surface temperature in the palmar metacarpal region. Mean ± SE; global test for PRPG and CG p < 0.001; Different letters (PRP normal and control italic) indicate significant differences (p < 0.05) within groups; PRPG = PRP-group: n = 10 limbs, SDFTs treated intralesionally with PRP; CG = control group: n = 10 limbs, SDFTs treated intralesionally with saline; black arrow = day 0: diagnosis, intralesional injection of PRP/saline; PRP = platelet-rich plasma; w = weeks; SDFT = superficial digital flexor tendon

Mentions: On day 0, 60 % (n = 6) of the horses included in the PRPG were lame. Fifty percent (n = 5) of the control horses showed a lameness. In all horses it was the lame limb where tendinopathy was diagnosed. After 24 weeks 2 horses in the PRPG were still lame and 1 horse in the CG was lame. The mean degree of lameness did not differ between groups on any day of examination. Compared to day 0 lameness decreased significantly by week 8 after treatment within the PRPG (p = 0.011) and it decreased significantly by week 12 in the CG (p = 0.014) (Fig. 1a).Fig. 1


Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial
Clinical findings after PRP and saline treatment of SDFT lesions over time. a Degree of lameness. b Scores for sensitivity to palpation. c Scores for skin surface temperature in the palmar metacarpal region. Mean ± SE; global test for PRPG and CG p < 0.001; Different letters (PRP normal and control italic) indicate significant differences (p < 0.05) within groups; PRPG = PRP-group: n = 10 limbs, SDFTs treated intralesionally with PRP; CG = control group: n = 10 limbs, SDFTs treated intralesionally with saline; black arrow = day 0: diagnosis, intralesional injection of PRP/saline; PRP = platelet-rich plasma; w = weeks; SDFT = superficial digital flexor tendon
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5015224&req=5

Fig1: Clinical findings after PRP and saline treatment of SDFT lesions over time. a Degree of lameness. b Scores for sensitivity to palpation. c Scores for skin surface temperature in the palmar metacarpal region. Mean ± SE; global test for PRPG and CG p < 0.001; Different letters (PRP normal and control italic) indicate significant differences (p < 0.05) within groups; PRPG = PRP-group: n = 10 limbs, SDFTs treated intralesionally with PRP; CG = control group: n = 10 limbs, SDFTs treated intralesionally with saline; black arrow = day 0: diagnosis, intralesional injection of PRP/saline; PRP = platelet-rich plasma; w = weeks; SDFT = superficial digital flexor tendon
Mentions: On day 0, 60 % (n = 6) of the horses included in the PRPG were lame. Fifty percent (n = 5) of the control horses showed a lameness. In all horses it was the lame limb where tendinopathy was diagnosed. After 24 weeks 2 horses in the PRPG were still lame and 1 horse in the CG was lame. The mean degree of lameness did not differ between groups on any day of examination. Compared to day 0 lameness decreased significantly by week 8 after treatment within the PRPG (p = 0.011) and it decreased significantly by week 12 in the CG (p = 0.014) (Fig. 1a).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Regenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n&thinsp;=&thinsp;10) or control group (n&thinsp;=&thinsp;10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry.

Results: Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24&nbsp;weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12&nbsp;months compared to 50&nbsp;% in the CG. After 24&nbsp;months these proportions were 60&nbsp;% and 50&nbsp;%, respectively.

Conclusions: A single intralesional treatment with PRP up to 8&nbsp;weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.

No MeSH data available.


Related in: MedlinePlus